=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245468644
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLEN T. CAHILL, O.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2009
-----------------------------------------------------
Last Update Date | 06/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 302 S MAIN ST
-----------------------------------------------------
City | OTTAWA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66067-2332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-242-4303
-----------------------------------------------------
Fax | 785-242-0238
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 302 S MAIN ST
-----------------------------------------------------
City | OTTAWA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66067-2332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-242-4303
-----------------------------------------------------
Fax | 785-242-0238
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GLEN T CAHILL
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 785-242-4303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1342
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------